The Shadow Practice, Part 7: Punishment for drug-dealing doctors more severe in Arizona
One doctor allowed her clinics in Santa Ana, California, to be used as front operations for selling highly addictive painkillers.
Another doctor agreed to be paid $2,000 a month for the use of his registration with the DEA so that the front operations could keep up their supply.
Another doctor was willing to rent his registration for half that.
All of them were caught red-handed by the U.S. Drug Enforcement Agency. Medical Board of California investigations are not made public, but, so far, none of them have been disciplined in California.
Antidote wondered whether other states took seriously the diversion of painkillers away from legitimate patients to people who don't even have to see a doctor to get their drugs. The first state we checked was Arizona, and the very first doctor turned out to be a perfect example.
The Arizona Medical Board stripped Dr. Thomas E. Cosmas of his license in February 2010. He had prescribed hydrocodone too frequently and without performing adequate evaluations to justify the prescriptions. He didn't keep enough records to support the prescriptions. The medical board wrote:
The standard of care to prescribing long-term opioid medications for chronic malignant pain requires a physician to conduct an appropriate evaluation of pain problem and to counsel the patient regarding the risks of the medications .A physician is required to maintain adequate legible medical records containing, at a minimum, sufficient information to identify the patient, support the diagnosis, justify the treatment, accurately document the results, indicate advice and cautionary warnings provided to the patient and provide sufficient information for another practitioner to assume continuity of the patient's care at any point in the course of treatment.
The board found that Cosmas had deviated from these standards and did not deserve the right to practice medicine. It took his license away, posted his disciplinary history, albeit quite abbreviated, on its Web site and reported him to the National Practitioner Data Bank.
It did all of this based on one patient who took drugs prescribed by Cosmas for six years. The patient, 37, ended up being hospitalized for "acute psychosis related to excessive hydrocodone."
The doctors described in last week's installment of The Shadow Practice – Dr. Joy Johnson, Dr. Scott Bickman and Dr. Thomas Mitchell – played a role in a scheme in California to use their medical licenses to help an unlicensed clinic operator distribute more than 1 million doses of hydrocodone to countless people. The doctors never saw the patients, never evaluated them, never counseled them of the risks of taking the drugs or made sure they were truly in need of the drugs for medical reasons in the first place.
Yet when a patient checks their profiles on the Medical Board of California's Web site, that patient will see nothing about the drug scheme and nothing about the DEA investigation that led to its ringleader losing his ability to prescribe painkillers and other narcotics.
Arizona clearly has its own problems with disciplining doctors. (See the case of Dr. Gary W. Hall, the ophthalmologist who seemed to be begging the medical board to take his license away.) But, when it comes to prescription drug problems, they have cracked down repeatedly in the past year.
Dr. Albert Szu Yun Yeh was busted by the DEA for "assisting a criminal syndicate, money laundering and administering narcotic drugs" at his Mohave County clinic. Within days of his federal indictment in July 2009, the Medical Board of Arizona restricted his license. By October, the board had taken it away.
A DEA investigation also prompted the Medical Board of Arizona to take a hard look at Dr. Frederick T. Strand. The agency had prohibited Strand from prescribing addictive narcotics in December 2009. The board looked ad 12 patients' records and, because of gaps, errors and a history of overprescribing, took Strand's license away in February 2010.
In June 2009, the board banned Dr. Gerald J. Taitague from prescribing controlled substances. And, to keep him honest, the board did something that few boards do. It checked with its sister agency, the Arizona Pharmacy Board, to see whether Taitague was following the rules. He was not. He was, in fact, prescribing Oxycontin to one patient repeatedly. By February 2010, the board had stripped Taitague of his license.
One patient, a dozen patients, it doesn't seem to matter. If you get caught dispensing prescription drugs like candy in Arizona, you will lose your license.
The same cannot be said for California.